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Efficacy of 100 consecutive right ventricular endomyocardial biopsies in pediatric patients using the right internal
1Department of Pediatrics, University of Utah, Salt Lake City.
Insights
Pediatric endomyocardial biopsy (EMB) using the internal jugular venous approach is safe and effective for diagnosing heart conditions and monitoring transplant rejection. This method allows for repeated biopsies in young children, ensuring comprehensive cardiac care.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Pathology
- Interventional Cardiology
Background:
- Endomyocardial biopsy (EMB) is crucial for diagnosing pediatric heart conditions like cardiomyopathy and post-transplant rejection.
- The right internal jugular venous approach for pediatric right ventricular EMB is less documented.
- This study evaluates the safety and efficacy of this specific approach in a pediatric cohort.
Purpose of the Study:
- To assess the feasibility and safety of performing pediatric endomyocardial biopsies via the right internal jugular venous approach.
- To determine the diagnostic yield of EMB in various pediatric cardiac conditions.
- To establish the safety of repeated EMB procedures in pediatric patients.
Main Methods:
- Retrospective analysis of 100 consecutive pediatric endomyocardial biopsies.
- Utilized the right internal jugular venous approach for all procedures.
- Evaluated indications, procedural success, complications, and histologic findings.
Main Results:
- Successful completion of 100 EMB procedures without complications.
- Diagnoses included cardiomyopathy, cardiotoxicity, tumors, and allograft rejection.
- The approach was safe and effective in infants as young as 2 months and repeatable in children as young as 8 years.
Conclusions:
- The right internal jugular venous approach is a safe and successful method for pediatric right ventricular EMB.
- This technique is suitable for initial diagnosis and serial monitoring in pediatric cardiac patients.
- EMB via this approach provides valuable diagnostic information across a spectrum of pediatric heart diseases.
Abstract:
Indications for endomyocardial biopsy (EMB) in pediatric patients include cardiomyopathy and postheart transplant rejection surveillance. There have been few reports of the use of the internal jugular venous approach for right ventricular EMB in pediatric patients. In this study, we report our experience with 100 consecutive EMBs in pediatric patients using this approach. Indications for EMB were cardiomyopathy of unknown etiology in four patients, adriamycin cardiomyopathy in three patients, postheart transplant rejection surveillance in five patients, right ventricular outflow tract tumors in one patient, and sustained ventricular tachycardia in one patient. Histologic diagnoses of biopsy specimens included interstitial fibrosis, vasculopathy, hypertrophy, anthracycline cardiotoxicity, and various degrees of allograft rejection. All EMBs were performed successfully and without complications. We conclude that right ventricular EMB using the right internal jugular venous approach can be performed safely and successfully in pediatric patients as young as 2 months of age and repeatedly in patients as young as 8 years old.